Conclusions on Substance Use and Economic Development

Communities with a strong economic base are in a much better position to address substance use issues within their communities. They do this by being able to offer employment in the context of post-treatment care, in being able to afford enriched treatment programs by drawing on own-source revenues, and in being able to put in place policies and programs that contribute not only to controlling substance use by reducing the supply or by providing a supportive environment such as human resource policies or recreational programs.

Our analysis of the Regional Health Survey data also showed empirically how those who used substances without a prescription had poorer employment-related outcomes than those who did not use substances.

We conclude that it is a sensible strategy to address issues of substance use not only onits own terms by focusing on clients, treatment and the like but also as part of larger community efforts to strengthen the economic base. Furthermore, it is advisable, when
making the case for funding to address substance use issues, that this go beyond a pitch that it is the right thing to do (a moral argument) or that the program is needed (people are suffering). This study suggests that a community can move ahead on the path to self reliance by addressing substance use within the community, because of all the connections that exist with the economic base.

Several recommendations flow from the results of this study:

1. That Atlantic-region First Nations consider framing the advantages of a strengthened community economy not only in terms of its contribution to jobs, businesses and incomes but also as a route to improved community health and wellbeing, including reduced substance use.
2. That the Atlantic Policy Congress (APC) pursue a process with Health Canada/FNIHB to monitor trends in substance use. For example, an Advisory Committee with appropriate representation including from FNIHB could be established to review trends in non-prescription substance use after the completion of new phases of the Regional Health Survey. Prescription substance use trends are already being monitored.
3. That APC lead a review of the findings of this report with respect to prescription and non-prescription substance use. The objective would be to work with FNIHB toward modifying national health and wellness programs so that they reflect the regional-specific information that has been provided. Additionally, flexibility in programs such as medical transportation and methadone clinics is required so that they can be tailored to meet the needs of different communities within the region.
4. Results from our case studies suggest that the most effective strategy for addressing substance use issues is one that is multi-faceted, involving aspects such as prevention, interruption of supply, treatment, aftercare, and adding cultural dimensions. It follows that action cannot be left only to health staff but requires the active involvement of Chief and Council and indeed of the whole community (e.g., to deal with reducing/eliminating supply, to put in place human resource policies, to provide supervised housing for aftercare and the like).
5. That APC develop a community-led process to engage in dialogue with methadone service providers (e.g., prescribing physicians or clinics) to ensure that community and patient-level treatment preferences are respected e.g., ensuring tapering options are offered where desired.
6. That APC continue to advocate for evidence-based harm reduction approaches to substance use.
7. That communities and APC continue to advocate for community-based access to mental health and addiction services that supplement one another, rather than existing in parallel systems or silos. The Mental Wellness Continuum Framework provides models for aligning culturally-appropriate services.
8. That APC repeat this research project in five years’ time as a means of updating information, including case studies. Doing so as part of a regular cycle will be helpful in understanding how shifts in economic and social determinants contribute to substance use or its reduction. Progress could be tracked using a regional scorecard approach to monitor whether programs are making a difference.
9. We have also noted how exceptional Miawpukek is with respect to substance use, and we recommend that interviews be conducted there in order to understand how that community has done so well in addressing this issue. (Wein et al, 2016 p.64)

The challenges of substance abuse are still challenges in Atlantic Canada First Nation Communities. Covid-19 may have increased substance abuse.

COVID-19 RESEARCH

The impact of the pandemic on both substance use and mental health is analyzed by income, employment status and access to mental health and substance use services. The extensive survey of more than 8,500 people living in Canada was conducted from October 2020 to May 2021.

Key findings include:

• Substance use and mental health concerns are greatest among people with low income or who are unemployed.
• Problematic cannabis use was reported by 50% of respondents with low income or who are unemployed who use cannabis, while problematic alcohol use was reported by more than 30% of those who drink alcohol.
• Similarly, 45% of respondents with low income or who are unemployed reported moderate to severe anxiety, and more than 30% reported moderately severe to severe depression.
• Among people with low income or who are unemployed, 25% reported finances as the top pandemic stress.
• More people are accessing virtual services, but rates of access remain low. Among those surveyed, 20% of those with mental health concerns reported accessing virtual services, compared with 10% of those with substance use concerns.
• People with low income or who are unemployed face significantly more barriers to mental health and substance use treatment services. The most commonly cited barriers include financial constraints, help not being readily available, not knowing how and where to get help, and long waitlists.

(Reference: https://www.ccsa.ca/mental-health-and-substance-use-during-covid-19)